Management of an esophagojejunal anastomotic stricture using a LAMS

Post written by Ryan Law, DO, from the Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan, USA.
Headshot_Ryan Law

We present a 56-year-old woman with history of lupus and laparoscopic Roux-en-Y gastric bypass (RYGB), complicated by a persistent anastomotic ulcer ultimately requiring partial gastrectomy and esophagojejunostomy who was referred for endoscopic management of an esophagojejunal (EJ) anastomotic stricture. Following multiple unsuccessful sessions of endoscopic balloon dilation, we elected to place a lumen-apposing stent (LAMS) across the anastomotic stricture for further treatment. Following placement of a 15-mm x 10-mm LAMS, the patient developed resolution of dysphagia. Repeat upper endoscopy 4 weeks later was performed, and the stent was removed. The anastomosis was widely patent. Five months following LAMS removal, the patient tolerated a near normal diet and her weight increased by 15 pounds. Of note, this is an off label use of a LAMS as it is not FDA-approved for this indication.

We believe that LAMSs may provide an effective management strategy for refractory short anastomotic strictures following failed serial endoscopic dilations.

This case demonstrates successful use of a LAMS for treatment of an anastomotic stricture after esophagojejunostomy. While this technique requires further evaluation, it should be considered as a viable option to more invasive interventions when conventional options are unsuccessful.

Read the full article online.

The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.

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